Please fill out the entire form to completion for consideration of staffing by Florence Nursing Services of Rocky Mount. After clicking the submit button at the bottom you will receive a confirmation email with the information you provide.

Please make sure you have the ability to upload the following items before you begin. 

State issued Identification
Social Security Card
Latest TB Testing Results
Any relevant certifications

File formats required are standard image files: .png, jpeg, .pdf, etc.

Please note that we are not affiliated with Florence Nursing Services located in South Carolina.

- - - Please fill out ALL fields before clicking Submit - Progress will not be saved if you click off this page - - -

Please upload an image of your valid Drivers License
Please upload an image of your social security card
Please enter your middle name for validation.
Please upload your TB results
Enter date of last COVID vaccination
Upload your vaccination card
Required for RNs & LPNs
Please list Facility Name & Dates of work.
Please list 2 work related reference names and numbers. By listing references below, you authorize Florence Nursing Service to obtain and release from liability anyone providing information on prior employment.
Fill out if different from Mailing Address
Fill out if different from Mailing Address
Fill out if different from Mailing Address
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How did you hear about Florence Nursing Services?
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